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Macroscopic hemorrhagic infarction following selective coronary thrombolysis in acute myocardial infarction
Insights
Selective coronary thrombolysis for acute myocardial infarction often leads to macroscopic bleeding in the heart. This hemorrhagic infarction typically develops around 15 hours after the event and resolves into fibrosis within two weeks.
Area of Science:
- Cardiovascular Pathology
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) is a leading cause of cardiac mortality.
- Selective coronary thrombolysis (SCT) is a treatment aimed at restoring blood flow.
- Hemorrhagic complications following thrombolysis require further investigation.
Purpose of the Study:
- To investigate the occurrence and characteristics of macroscopic hemorrhagic infarction after SCT in AMI patients.
- To determine the temporal relationship between SCT and the development of hemorrhage.
- To assess the resolution of hemorrhagic infarction.
Main Methods:
- Autopsy study of 14 hearts from patients treated with SCT for AMI.
- Urokinase selectively injected into coronary arteries 2-7 hours post-AMI.
- Patients classified into three stages based on time of death (4-9 hours, 15 hours-11 days, 19 days-12 months).
Main Results:
- Macroscopic hemorrhage was evident in 6 of 7 hearts in Stage II (15 hours to 11 days).
- Hemorrhagic infarction became macroscopically definite around 15 hours post-AMI in most cases.
- Cardiac rupture occurred in 4 of 10 patients in Stages I and II.
- Massive fibrosis replaced hemorrhagic infarction after approximately 2 weeks.
Conclusions:
- Macroscopic bleeding is a common finding in AMI patients treated with SCT.
- Hemorrhagic infarction develops gradually after SCT, becoming evident around 15 hours post-AMI.
- Hemorrhagic changes resolve into fibrosis, typically within two weeks.
Abstract:
Macroscopic hemorrhagic infarction was studied in 14 autopsied hearts with selective coronary thrombolysis (SCT) after acute myocardial infarction (AMI). In all patients urokinase, 240,000 - 720,000 units, had been selectively injected into ischemia-related coronary artery at 2 - 7 hours after the onset of AMI. The degree of stenosis after SCT was 90 - 99% in 13 patients and 100% in one patient. According to the duration of illness at death, the 14 patients were classified into 3 stages; stage I: 4 - 9 hours; stage II: 15 hours to 11 days; stage III: 19 days to 12 months. Three hearts in stage I had no macroscopic hemorrhage. In stage II, marked and diffuse hemorrhage in the infarct area was macroscopically evident in 6 of 7 hearts. In a stage II patient, extravasation of contrast medium into the myocardium was found at 3 hours after the onset of AMI. In stage III, 4 hearts had massive fibrosis or granulation in the left ventricular wall without macroscopic hemorrhage. Cardiac rupture was seen in 4 of 10 patients from stages I and II. It is concluded that macroscopic bleeding appears in most patients with AMI treated with coronary thrombolysis. In the majority of cases, the hemorrhage increases gradually after SCT and becomes macroscopically definite approximately 15 hours after the onset of AMI. Rarely, massive bleeding appears earlier. Hemorrhagic infarction is replaced by massive fibrosis after approximately 2 weeks.